POSOLOGY

POSOLOGY is derived from the Greek word posos meaning how much

and logos meaning science. So Posology is the branch of medicine dealing with doses.

The optimum dose of a drug varies from patient to patient. The following are some of
the factors that influence the dose of a drug.

1. Age: Human beings can be categorized into the following age groups:

1.       Neonate:       From birth up to 30days.

2.       Infant:            Up to 1 year age

3.       Child in between 1 to 4 years

4.       Child in between 5 to 12 years.

5.       Adult

6.       Geriatric (elderly) patients

In children the enzyme systems in the liver and renal excretion remain less developed.
So all the dose should be less than that of an adult. In elderly patients the renal functions
decline. Metabolism rate in the liver also decreases. Drug absorption from the intestine
becomes slower in elderly patients. So in geriatric patients the dose is less and should
be judiciously administered.

Young’s Rule: (used when age is less than 12 Yrs): Age in years/ Age in years + 12

Cowling’s Rule: (used when age is more than 2 Yrs): Adult dose * (Age in years + 1)/24)

Fried’s Rule: (used when age is more than 1 Year): (Age in months/150) * Adult dose

Dilling’s Rule: (used when age is more between 4 to 20 Years): Age in years/20 * Adult dose

2. Sex: Special care should be taken while administering any drug to women during
menstruation, pregnancy and lactation. Strong purgatives should not be given in
menstruation and pregnancy. Antimalarial, ergot alkaloids should not be taken during
pregnancy to avoid deformation of foetus. Antihistaminic and sedative drugs are not
taken during breast feeding because these drugs are secreted in the milk and the child
may consume them.

3. Body size: It influences the concentration of drug in the body. The average adult dose
is calculated for a person with 70kg body weight (BW). For exceptionally obese (fat) or
lean (thin) patient the dose may be calculated on body weight basis.
Body surface area (BSA): This method is more accurate than the body weight method.

Use either a nomogram chart to fine the body surface area or use Mosteller’s Rule for
calculating Body Surface Area.

Mosteller’s Rule: Body surface area BSA=√ (𝑤𝑒𝑖𝑔ℎ𝑡 in 𝑘𝑔 * ℎ𝑒𝑖𝑔ℎt in 𝑐𝑚/3600)

BSA (m2) = (𝑤𝑒𝑖𝑔ℎ𝑡 in 𝑘𝑔 * ℎ𝑒𝑖𝑔ℎt in 𝑐𝑚 /3600)½

or

Body surface area BSA=√ (𝑤𝑒𝑖𝑔ℎ𝑡 in lb * ℎ𝑒𝑖𝑔ℎt in 𝑐𝑚/3131)

BSA (m2) = (𝑤𝑒𝑖𝑔ℎ𝑡 in lb * ℎ𝑒𝑖𝑔ℎt in 𝑐𝑚/3131)½

Catzel’s rule: 𝐷𝑜𝑠𝑒 𝑓𝑜𝑟 𝑡ℎ𝑒 𝑐ℎ𝑖𝑙𝑑 = S𝑢𝑟𝑓𝑎𝑐𝑒 𝑎𝑟𝑒𝑎 𝑜𝑓 𝑐ℎ𝑖𝑙𝑑 𝑠𝑢𝑟𝑓𝑎𝑐𝑒 𝑎𝑟𝑒𝑎 𝑜𝑓 𝑎𝑑𝑢𝑙𝑡 *
𝑎𝑑𝑢𝑙𝑡 𝑑𝑜𝑠𝑒

The average body surface area for an adult=1.73m 2

Hence 𝐷𝑜𝑠𝑒 𝑓𝑜𝑟 𝑡ℎ𝑒 𝑐ℎ𝑖𝑙𝑑 = 𝑠𝑢𝑟𝑓𝑎𝑐𝑒 𝑎𝑟𝑒𝑎 𝑜𝑓 𝑐ℎ𝑖𝑙𝑑 1.73𝑚2 * 𝑎𝑑𝑢𝑙𝑡 𝑑𝑜𝑠𝑒

The body surface area (BSA) of an individual can be obtained from the following
formula:

BSA (m2) = Body Weight (kg)0.425  *  Height (cm)0.725  *  0.007184

4. Body Weight:

Clarke’s Rule: (Weight in Kg/70) * adult dose (mg) or (Weight in Lbs/150) * adult dose

Augsberger Rule: 1.5 * weight (kg) + 10 = % of adult dose.

5. Route of administration

In case of intravenous injection the total drugs reaches immediately to the systemic
circulation hence the dose is less in i.v. injection than through oral route or any other
route.

In general, the rapidity of absorption of a drug decreases with route of administration in

the following order:

Intravenous > Intramuscular > Subcutaneous > Oral

Thus, in general, intravenous (intravenous) dose of a drug is smaller than its

intramuscular (intramuscular) or subcutaneous or oral dose.

Example: Doses of ergotamine for various routes are as follows.

Oral: 2 to 5 mg
Intramuscular: 1 mg (about to 1/2 of oral dose)

Intravenous: 0.25 mg (about to 1/8 of oral dose and % of IM dose)

6. Time of administration

The drugs are most quickly absorbed from empty stomach. The presence of food in the
stomach delays the absorption of drugs. Hence a potent drug is given before meal. An
irritant drug is given after meal so that the drug is diluted with food and thus produces
less irritation.

7. Environmental factors

Stimulant types of drug are taken at day time and sedative types of drugs are taken at
night. So the dose of a sedative required in day time will be much higher than at night.

Alcohol is better tolerated in winter than in summer.

8. Psychological state

Psychological state of mind can affect the response of a drug, e.g. a nervous and anxious
patient requires more general anaesthetics. Placebo is an inert substance that does not
contain any drug. Commonly used placebos are lactose tablets and distilled water
injections. Some time patients often get some psychological effects from this placebo.
Placebos are more often used in clinical trials of drugs.

9. Pathological states (i.e. Presence of disease)

Several diseases may affect the dose of drugs:

In gastrointestinal disease like Achlorhydria (reduced secretion of HCl acid in the

stomach) the absorption of aspirin decreases.

In liver disease (like liver cirrhosis) metabolism of some drugs (like morphine,

Pentobarbitone etc.) decreases.

In kidney diseases excretion of drugs (like Aminoglycosides, digoxin, Phenobarbitone) is

reduced, so less dose of the drugs should be administered.

10. Accumulation

Any drug will accumulate in the body if the rate of absorption is more than the rate of
elimination. Slowly eliminated drugs are often accumulated in the body and often
causes toxicity e.g. prolonged use of Chloroquin causes damage to retina.

11. Drug interactions

Simultaneous administration of two drugs may result in same or increased or decrease

effects.
 Drug administration Pharmacological
with dose effect

Drug A Effect A

Drug B Effect B

Drug A + Drug B Effect AB

Relationship Name of the effect Examples

Effect AB = Effect A + Effect B Additive effect Aspirin + Paracetamol

Effect AB > Effect A + Effect B Synergistic (or Sulfamethaxazole +

Potentiation) Trimethoprim

Effect AB < Effect A + Effect B Antagonism Histamine + Adrenaline

12. Idiosyncrasy

"An unusual response or a highly exaggerated usual response to

usual doses to some drugs in few individuals"
This is an exceptional response to a drug in few individual patients. For example, in
some patients, aspirin may cause asthma, penicillin causes irritating rashes on the skin
etc.

Idiosyncrasy is an abnormal reactivity to a chemical that is peculiar to a given

individual. It could be:
An abnormally exaggerated response, or an abnormal lack of response,
a response unusual because it requires an unusually small or unusually large dose,
an extension of the normal physiological drug effect,
a reaction which is unrelated to the expected physiological effect.

Idiosyncrasy is not a drug allergy, but both are forms of adverse drug reaction,
Idiosyncratic drug reactions are unrelated to the dose of the drug.

Common life threatening idiosyncratic drug reactions include DRESS syndrome, Toxic
Epidermal necrolysis and Stevens-Johnson syndrome eg: Phenytoin, Sulfonamides,
Allopurinol, NSAIDs, Beta-lactams
Eg. Morphine normally depresses central nervous system but may produce excitation in
some individuals, especially in women.

13.    Genetic diseases
Some patients may have genetic defects. They lack some enzymes. In those cases some
drugs are contraindicated.

E.g. Patients lacking Glucose-6-phosphate dehydrogenase enzyme should not be

given Primaquin (an Antimalarial drug) because it will cause haemolysis.

14. Tolerance

Some time higher dose of a drug is required to produce a given response (previously less
dose was required).

a. Natural Tolerance: Some races are inherently less sensitive to some drugs, e.g.
rabbits and black race (Africans) are more tolerant to atropine.

b. Acquired Tolerance: By repeated use of a drug in an individual for a long time

require larger dose to produce the same effect that was obtained with normal dose
previously.

c. Cross tolerance: It is the development of tolerance to pharmacologically related

drugs e.g. alcoholics are relatively more tolerant to sedative drugs.

d. Tachyphylaxis: (Tachy = fast, phylaxis = protection) is rapid development of

tolerance. When doses of a drug are repeated in quick succession an reduction in
response occurs – this is called tachyphylaxis. This is usually seen in ephedrine,
nicotine.

Drug resistance: It refers to tolerance of microorganisms to inhibitory action of

antimicrobials e.g. Staphylococci to penicillin.